A neural network for prediction of risk of nosocomial infection at intensive care units: a didactic preliminary model

OBJECTIVE: To propose a preliminary artificial intelligence model, based on artificial neural networks, for predicting the risk of nosocomial infection at intensive care units. METHODS: An artificial neural network is designed that employs supervised learning. The generation of the datasets was based on data derived from the Japanese Nosocomial Infection Surveillance system. It is studied how the Java Neural Network Simulator learns to categorize these patients to predict their risk of nosocomial infection. The simulations are performed with several backpropagation learning algorithms and with several groups of parameters, comparing their results through the sum of the squared errors and mean errors per pattern. RESULTS: The backpropagation with momentum algorithm showed better performance than the backpropagation algorithm. The performance improved with the xor. README file parameter values compared to the default parameters. There were no failures in the categorization of the patients into their risk of nosocomial infection. CONCLUSION: While this model is still based on a synthetic dataset, the excellent performance observed with a small number of patterns suggests that using higher numbers of variables and network layers to analyze larger volumes of data can create powerful artificial neural networks, potentially capable of precisely anticipating nosocomial infection at intensive care units. Using a real database during the simulations has the potential to realize the predictive ability of this model

Relationship between admission serum C-reactive protein and short term outcome following acute ischaemic stroke at a tertiary health institution in Nigeria

Background: There is evidence of an association between mediators of inflammation, particularly C-reactive protein (CRP), and outcome of acute ischaemic stroke. This provides a potential opportunity for interventions aimed at improving outcome. There is sparse data exploring the role of inflammatory markers such as CRP and stroke outcome in Africans. The study objective was to determine the association between admission serum CRP levels and short-term outcome in the Nigerian patient presenting with acute ischaemic stroke.Materials and Methods: Consecutive patients hospitalized for first-ever acute ischaemic stroke at the Lagos University Teaching Hospital, Lagos, Nigeria, were prospectively enrolled between October 2007 and June 2008. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Serum CRP was determined on samples obtained within 7 days of stroke onset. All stroke patients were followed up till day 30 post-stroke. Outcome measures were 30 day Glasgow outcome scale score and functional impairment on the modified Rankin Scale (mRS). An age- and gender-matched healthy control group had serum CRP determined at inclusion. Elevated CRP was defined as any level above the cutoff (mean +2 x standard deviation of CRP level of controls).Results: Eighty patients with acute ischaemic stroke (47 men and 33 women) and 40 controls (27 male and 13 female) (P = 0.47) were studied. Mean age in cases was 59.1 ± 15.0 years. Mean CRP was significantly higher in stroke cases than controls (17.7 ± 14.4 mg/L versus 1.1 ± 1.7 mg/L respectively) (P < 0.00001). The frequency of elevated CRP (>4.5 mg/L) was 76.3% in stroke (N = 61) and 5% (N = 2) in controls (P < 0.0001). The case fatality rate in stroke with elevated CRP (32.8%) was significantly higher than stroke with normal admission CRP (0%; P= 0.015). The association of higher admission CRP with fatality () was statistically significant (P < 0.0001). Amongst survivors, mean CRP levels were markedly higher in the patients with unfavorable motor outcome (moderate/severe disability; n = 22; 21.5 ± 11.1) compared to those with favorable outcome (mild disability; n = 38; 6.5 ± 6.2) (P < 0.00001). In multivariate regression analysis, only high NIHSS score (P = 0.004) and admission CRP (P = 0.008) were independently associated with case fatality.Conclusions: Elevated admission CRP and high NIHSS score are independent predictors of short-term case fatality and adverse functional outcome following acute ischaemic stroke in Nigerians.Key words: C-reactive protein, ischaemic stroke, outcom

Strategic Manufacturing Planning Decision Support System

Industrial Engineering and Managemen

Diagn?stico sobre la implementaci?n del sistema institucional de evaluaci?n de los estudiantes (siedes) seg?n el decreto 1290 de 2009, en la instituci?n educativa Manuel Elkin Patarroyo de la ciudad de Girardot

211 P?ginasLa investigaci?n ?Diagn?stico sobre la implementaci?n del Sistema Institucional de Evaluaci?n de los Estudiantes (SIE) seg?n el decreto 1290 de 2009 en la Instituci?n Educativa Manuel Elkin Patarroyo de la ciudad de Girardot? pretende valorar el proceso de implementaci?n del SIE, el cual direcciona la evaluaci?n de los aprendizajes y la promoci?n de los estudiantes en los niveles de b?sica y media. Para lograr identificar los aspectos abordados en la investigaci?n se tom? una muestra de directivos docentes, docentes, estudiantes y padres de familia, a quienes se les aplicaron entrevistas. Igualmente se realiz? una revisi?n documental sobre el Proyecto Educativo Institucional (PEI), el SIE y las actas de los consejos acad?mico, de padres y directivo, para determinar su articulaci?n y pertinencia. As? se pudo detectar que se hab?an omitido algunos requerimientos propuestos en el decreto y que no hay una apropiaci?n del concepto de evaluaci?n, sus fines y funciones, seg?n lo propuesto en el decreto 1290 en general, ni del SIEDES, en particular. Con base en los resultados, se realiza una gu?a metodol?gica que brinda orientaciones sobre aquellos aspectos que no se tuvieron en cuenta durante el proceso de implementaci?n del SIEDES, los cuales no han permitido que se convierta en una herramienta valiosa que ofrece informaci?n sobre los procesos educativos que giran en torno a ella y que aseguran un avance en la mejora de la educaci?n que ofrece la instituci?n.ABSTRACT The research "Diagnosis on the implementation of the Institutional System of Student Assessment (SIE) by decree 1290 of 2009 in Manuel Elkin Patarroyo school from Girardot city" analyzes the implementation process of the SIE, which addresses the evaluation of learning and the promotion of students in elementary and secondary levels. In order to identify the issues raised in the research, we took as sample school administrators, teachers, students and parents, who were applied interviews. Also a literature review on the Institutional Education Project (PEI) and the Institutional System of Student Assessment (SIEDES) and proceedings of teachers administrators, teachers and parents councils were conducted to determine its articulation and relevance. Thus it was possible to detect that were omitted some proposed in the decree 1290 requirements and that there is no appropriation by the majority of the educational community, the concept of evaluation, its purposes and functions, as proposed in the decree 1290 generally or the SIEDES in particular. Based on the results, a methodological guide that provides guidance on those aspects that were not taken into account during the implementation process SIEDES, which have not allowed it to become a valuable tool that provides information on educational processes are performed revolving around it and ensuring progress in improving the education offered by the school.INTRODUCCION 19 1. PROBLEMA 23 1.1 DESCRIPCI?N DEL PROBLEMA 23 1.2 PREGUNTA DE INVESTIGACI?N 24 2. JUSTIFICACI?N 25 3. OBJETIVOS 27 3.1 OBJETIVO GENERAL 27 3.2 OBJETIVOS ESPECIFICOS 27 4.LA EVALUACI?N EN LA EDUCACI?N28 4.1 CONCEPTO DE EVALUACI?N 28 4.2 FUNCIONES Y FINES DE LA EVALUACI?N 31 4.3 TIPOLOG?A DE LA EVALUACI?N 33 4.3.1 Evaluaci?n sumativa. 33 4.3.2 Evaluaci?n formativa.. 34 4.3.3 La evaluaci?n seg?n su normotipo.. 35 4.3.4 La evaluaci?n seg?n su temporalizaci?n. 35 4.3.5 La evaluaci?n seg?n sus agentes. 37 4.3.6 Evaluaci?n de competencias 38 4.3.6.1 Una aproximaci?n hist?rica a su concepto 38 4.3.6.2 Rasgos de complejidad de las competencias38 4.4 HISTORIA DE LA EVALUACI?N EN COLOMBIA 40 4.5 SOBRE DECRETO 1290, SISTEMAS INSTITUCIONALES DE EVALUACI?N 42 4.6 UNA MIRADA AL PROCESO DE IMPLEMENTACI?N DEL DECRETO DE EVALUACI?N 1290 DE 2009 EN ALGUNAS INSTITUCIONES EDUCATIVAS DE COLOMBIA 44 5. METODOLOG?A 48 5.1 TIPO DE INVESTIGACI?N 48 5.2 PARTICIPANTES 48 5.3 PROCESO DE LA INVESTIGACI?N 50 5.3.1 Planeaci?n, dise?o y organizaci?n del estudio 50 5.3.2 Indagaci?n y construcci?n te?rica. 50 5.3.3 Desarrollando las fases del anteproyecto, planteamiento del problema, justificaci?n, objetivos, revisi?n de antecedentes. 50 5.3.3.1 Implementaci?n y desarrollo del proyecto. 50 5.4 CATEGOR?AS DE AN?LISIS 52 6. RESULTADOS Y AN?LISIS DE LAS ENTREVISTAS 54 6.1 TABULACION Y AN?LISIS DE LOS DATOS OBTENIDOS DE LA ENTREVISTA APLICADA A LOS DIRECTIVOS DOCENTES 54 6.2. TABULACI?N Y AN?LISIS DE LA ENTREVISTA REALIZADA A DOCENTES 56 6.3. TABULACI?N Y AN?LISIS DE LAS ENTREVISTAS REALIZADAS A ESTUDIANTES 58 9 6.4. TABULACI?N Y AN?LISIS DE LOS DATOS OBTENIDOS DE LA ENTREVISTA APLICADA A LOS PADRES DE FAMILIA 59 6.5 INTERPRETACI?N DE LOS RESULTADOS. CATEGOR?A 1: QU? ES LA EVALUACI?N. 60 6.6 TABULACI?N Y AN?LISIS DE LA ENTREVISTA APLICADA A DIRECTIVOS DOCENTES. CATEGOR?A 2. ASPECTOS GENERALES DEL DECRETO 1290 62 6.7 TABULACI?N Y AN?LISIS DE LA ENTREVISTA APLICADA A DOCENTES 63 6.8 TABULACI?N Y AN?LISIS DE LA ENTREVISTA APLICADA A ESTUDIANTES 65 6.9 TABULACI?N Y AN?LISIS DE LA ENTREVISTA APLICADA A PADRES DE FAMILIA 66 6.10 INTERPRETACI?N DIMENSI?N DOS: ASPECTOS GENERALES DEL DECRETO 11290 DE 2009 68 6.11 TABULACION Y AN?LISIS DE LOS DATOS OBTENIDOS DE LA ENTREVISTA APLICADA A LOS DIRECTIVOS DOCENTES. CATEGOR?A 3: PROCESO DE CONSTRUCCI?N E IMPLEMENTACI?N DEL SIE. 69 6.12. TABULACI?N Y AN?LISIS DE LOS DATOS OBTENIDOS DE LA ENTREVISTA APLICADA A LOS DOCENTES 74 6.13 TABULACI?N Y AN?LISIS DE LOS DATOS OBTENIDOS DE LA ENTREVISTA APLICADA A LOS ESTUDIANTES 79 6.14 TABULACI?N Y AN?LISIS DE LOS DATOS OBTENIDOS DE LA ENTREVISTA APLICADA A LOS PADRES DE FAMILIA 80 6.15. INTERPRETACI?N DE LOS RESULTADOS DIMENSI?N 3: PROCESO E IMPLEMENTACION DEL SIE 81 6.16 TABULACION Y AN?LISIS DE LOS DATOS OBTENIDOS DE LA ENTREVISTA APLICADA A LOS DIRECTIVOS DOCENTES. CATEGOR?A 4: APROBACI?N Y DIVULGACI?N DEL SIEDES 83 6.17 TABULACI?N Y AN?LISIS DE LOS DATOS OBTENIDOS DE LA ENTREVISTA APLICADA A LOS DOCENTES 86 10 6.18. TABULACI?N Y AN?LISIS DE LOS DATOS OBTENIDOS DE LA ENTREVISTA APLICADA A LOS ESTUDIANTES 88 6.19. TABULACI?N Y AN?LISIS DE LOS DATOS OBTENIDOS DE LA ENTREVISTA APLICADA A LOS PADRES DE FAMILIA 89 6.20 INTERPRETACI?N DE LOS RESULTADOS. DIMENSI?N 4: APROBACI?N Y DIVULGACI?N DEL SIEDES 90 6.21 AN?LISIS E INTERPRETACI?N DE LAS ENTREVISTAS APLICADAS A DIRECTIVOS. DIMENSI?N 5: CAMBIOS EN LAS PR?CTICAS EVALUATIVAS GENERADAS A PARTIR DEL DECRETO 1290 92 6.22. AN?LISIS E INTERPRETACI?N DE LAS ENTREVISTAS APLICADAS A DOCENTES. CATEGOR?A 5: CAMBIOS EN LAS PR?CTICAS EVALUATIVAS GENERADAS A PARTIR DEL DECRETO 1290 96 6.23. AN?LISIS E INTERPRETACI?N DE LAS ENTREVISTAS APLICADAS A ESTUDIANTES. CATEGOR?A 5: CAMBIOS EN LAS PR?CTICAS EVALUATIVAS GENERADAS A PARTIR DEL DECRETO 1290 99 6.24. AN?LISIS E INTERPRETACI?N DE LAS ENTREVISTAS APLICADAS A PADRES DE FAMILIA. CATEGOR?A 5: CAMBIOS EN LAS PR?CTICAS EVALUATIVAS GENERADAS A PARTIR DEL DECRETO 1290 102 6.25 INTERPRETACI?N DE LOS RESULTADOS. CATEGOR?A 5. CAMBIOS EN LAS PR?CTICAS EVALUATIVAS GENERADAS A PARTIR DEL SIEDES REGLAMENTADO POR EL DECRETO 1290. 103 6.26 TABULACI?N Y AN?LISIS DE LA ENTREVISTA APLICADA A DIRECTIVOS DOCENTES. DIMENSI?N SEIS. SEGUIMIENTO DE EVALUACI?N AL SIEE 105 7. CONCLUSIONES 109 RECOMENDACIONES 111 REFERENCIAS 11

?Va a quedar una sanidad m?s integrada y digitalizada tras la COVID-19?

Comentario publicado en el Blog ECONOM?A Y SALUD de la Asociaci?n de Econom?a de la Salud (AES) sobre el IX Congreso de Gesti?n Cl?nica bajo el lema ?Atenci?n Integrada Efectiva: Imperativo Postcovid-19?, celebrado en santander en octubre de 2021. Disponible en: https://www.aes.es/blog/2022/01/12/va-a-quedar-una-sanidad-mas-integrada-y-digitalizada-tras-la-covid-19

Clinical profile of parkinsonism and Parkinson's disease in Lagos, Southwestern Nigeria

<p>Abstract</p> <p>Background</p> <p>Current data on the pattern of parkinsonism and Parkinson's disease in Nigerians are sparse.</p> <p>This database was designed to document the clinical profile of PD in Nigerians, and compare this to prior observations.</p> <p>Methods</p> <p>A database of patients presenting to the Neurology out-patients clinic of the Lagos University Teaching Hospital was established in October 1996. Demographic and clinical data at presentation (disease stage using Hoehn and Yahr scale; 'off' state severity on the Unified Parkinson's disease Rating Scale) were documented for patients diagnosed with parkinsonism between October 1996 and December 2006. Cases were classified as Parkinson's disease or secondary parkinsonism (in the presence of criteria suggestive of a secondary aetiology).</p> <p>Results</p> <p>The hospital frequency of parkinsonism (over a 2-year period, and relative to other neurologic disorders) was 1.47% (i.e. 20/1360). Of the 124 patients with parkinsonism, 98 (79.0%) had PD, while 26 (21.0%) had secondary parkinsonism. Mean age (SD) at onset of PD (61.5 (10.0) years) was slightly higher than for secondary parkinsonism (57.5 (14.0) years) (P = 0.10). There was a male preponderance in PD (3.3 to 1) and secondary parkinsonism (2.7 to 1), while a positive family history of parkinsonism was present in only 1.02% (1/98) of PD. There was a modestly significant difference in age at onset (SD) of PD in men (60.3 (10.4)) compared to women (65.2 (7.9)) (T = 2.08; P = 0.04). The frequency of young onset PD (≤ 50 years) was 16.3% (16/98). The mean time interval from onset of motor symptoms to diagnosis of PD was 24.6 ± 26.1 months with majority presenting at a median 12 months from onset. On the H&Y scale, severity of PD at presentation was a median 2.0 (range 1 to 4). PD disease subtype was tremor-dominant in 31 (31.6%), mixed 54 (55.1%) and akinetic-rigid 14 (14.3%). Hypertension was present as a co-morbidity in 20 (20.4%), and diabetes in 6 (6.12%).</p> <p>Conclusions</p> <p>The clinical profile of PD in Nigerians is similar to that in other populations, but is characterized by delayed presentation as has been reported in other developing countries. Young-onset disease occurs but may be less commonly encountered, and frequency of a positive family history is lower than in western populations.</p

Indicadores del uso hospitalario de antimicrobianos basados en el consumo.

OBJECTIVE: To identify indicators of hospital use of antimicrobials from the benchmark analysis of consumption data between hospitals at the same level through the collective judgement of a group of experts. METHOD: A committee formed by members of the Spanish Societies of Hospital Pharmacy and Infectious Diseases and Clinical Microbiology prepared a proposal of indicators which was submitted to consensus by a panel of 21 experts on infectious diseases, microbiology and antimicrobial therapy, through a modified Delphi method. The panel underwent two rounds of scores by e-mail. Participants assigned a score from 1 (completely disagree) to 9 (completely agree) to the relevance of each indicator in four dimensions: scientific evidence, efficacy and safety, ecological impact and cost. Scores were processed according to the RAND- UCLA method. An indicator was considered to be relevant if at least one dimension other than cost obtained a median score equal to or higher than 7 without disagreement among the panel. RESULTS: The committee submitted an initial proposal of 14 indicators. After the first round of panel scores, one indicator was ruled out and two were modified for moving on to the second round. Finally, 13 indicators were considered relevant. CONCLUSIONS: Determining indicators of the hospital use of antimicrobial agents based on consumption can allow the antimicrobial stewardship programs to detect any potential problems with the use of antimicrobial agents, and to help guide their efforts in order to implement actions of improvement, as well as to assess the impact of the measures implemented

Leucine rich repeat kinase 2 (LRRK2) GLY2019SER mutation is absent in a second cohort of Nigerian Africans with Parkinson disease

To date the LRRK2 p.G2019S mutation remains the most common genetic cause of Parkinson disease (PD) worldwide. It accounts for up to 6% of familial and approximately 1.5% of sporadic cases. LRRK2 has a kinase enzymatic domain which provides an attractive potential target for drug therapies and LRRK2 kinase inhibitors are in development. Prevalence of the p.G2019S has a variable ethnic and geographic distribution, the highest reported among Ashkenazi Jews (30% in patients with familial PD, 14% in sporadic PD, 2.0% in controls) and North African Berbers (37% in patients with familial PD, 41% in sporadic PD, and 1% in controls). Little is known about the frequency of the LRRK2 p.G2019S among populations in sub-Saharan Africa. Our group and others previously reported that the p.G2019S is absent in a small cohort of Nigerian PD patients and controls. Here we used Kompetitive Allele Specific PCR (KASP) assay to screen for the p.G2019S in a larger cohort of Black African PD patients (n = 126) and healthy controls (n = 54) from Nigeria. Our analysis confirmed that all patients and controls are negative for the p.G2019S mutation. This report provides further evidence that the LRRK2 p.G2019S is not implicated in PD in black populations from Nigeria and support the notion that p.G2019S mutation originated after the early human dispersal from sub-Saharan Africa. Further studies using larger cohorts and advance sequencing technology are required to underpin the genetic causes of PD in this region

Hydrodynamics of galactic dark matter

We consider simple hydrodynamical models of galactic dark matter in which the galactic halo is a self-gravitating and self-interacting gas that dominates the dynamics of the galaxy. Modeling this halo as a sphericaly symmetric and static perfect fluid satisfying the field equations of General Relativity, visible barionic matter can be treated as ``test particles'' in the geometry of this field. We show that the assumption of an empirical ``universal rotation curve'' that fits a wide variety of galaxies is compatible, under suitable approximations, with state variables characteristic of a non-relativistic Maxwell-Boltzmann gas that becomes an isothermal sphere in the Newtonian limit. Consistency criteria lead to a minimal bound for particle masses in the range $30 \hbox{eV} \leq m \leq 60 \hbox{eV}$ and to a constraint between the central temperature and the particles mass. The allowed mass range includes popular supersymmetric particle candidates, such as the neutralino, axino and gravitino, as well as lighter particles ($m\approx$ keV) proposed by numerical N-body simulations associated with self-interactive CDM and WDM structure formation theories.Comment: LaTeX article style, 16 pages including three figures. Final version to appear in Classical and Quantum Gravit